Hesi Flashcards

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The principal manifestation of ulcers is an aching, burning, cramp-like, gnawing pain. The pain has a definite relationship to eating. With gastric ulcers, food may cause the pain and vomiting may relieve it. Clients with duodenal ulcers have pain with an empty stomach, and discomfort may be relieved by ingestion of food or antacids. Clients usually describe the pain as circumscribed in an area 2 to 10 cm (0.8 to 4 inches) in diameter, between the xiphoid cartilage and the umbilicus.

provide stomach rest.Neutralize or buffer hydrochlorich acid.

coffee, alcohol, protein foods, and milk.

Hemorrhage, perforation, and obstruction

black stool.. hemorrhage tends to occur more with gastric ulcers.

Vagotomy is performed to eliminate the acid-secreting stimulus to gastric cells. Truncal vagotomy is each vagus nerve is completely cut. Selective vagotomy The surgeon partially severs the nerves to preserve the hepatic and celiac branches.
3 Proximal vagotomy. Partial cutting is performed, but only the parietal cell mass is denervated; innervation of both the antrum and the pyloric sphincter is preserved.

*Cutting the vagal nerve fibers selectively avoids the problems of impaired emptying and diarrhea that follow the truncal vagotomy. It also eliminates the necessity for a drainage anastomosis to offset gastric stasis. Proximal vagotomy also reduces acid secretion and preserves the function of the antrum.

facilitates emptying of stomach content

A marginal ulcer can develop where gastric acids come in contact with the operative site, either at the site of the anastomosis or in the jejunum. Ulceration may cause scarring and obstruction. Hemorrhage and perforation can also occur at the surgical site.

Alkaline reflux gastritis caused by duodenal contents occurs after gastric surgery in which the pylorus has been bypassed or removed. It also occurs after pyloroplasty and gastrojejunostomy. Usually, an associated vagotomy has been performed, which decreases gastric motility, allowing reflux of duodenal contents into the stomach.

This postprandial problem occurs after gastrojejunostomy because ingested food rapidly enters the jejunum without proper mixing and without the normal duodenal digestive processing. It usually subsides in 6 to 12 months. Early manifestations, which occur 5 to 30 minutes after eating, involve the vasomotor disturbances of vertigo, tachycardia, syncope, sweating, pallor, palpitation, diarrhea, and nausea with a desire to lie down. The client's blood pressure and pulse may either rise or fall.

Late manifestations, which occur 2 to 3 hours after eating, are a result of rapid entry of high-carbohydrate food into the jejunum, an increase in blood glucose level, and excessive insulin levels.

Management involves decreasing the amount of food taken at one time and maintaining a high-protein, high-fat, low-carbohydrate, dry diet. Gastric emptying can be delayed by eating in a recumbent or semi-recumbent position, lying down after meals, increasing the fat content in the diet, and avoiding fluids 1 hour before, with, or 2 hours after meals.The client may also be given sedatives and antispasmodic agents to delay gastric emptying. When manifestations persist, surgical intervention may include reducing the size of the gastroenterostomy or converting a Billroth II resection to a Billroth I by inserting a short segment of jejunum between the duodenal stump and the stomach.

Duodenal ulcers occur on both the anterior and posterior walls; anterior wall ulcers may produce tenderness on palpation of the abdomen. Patients generally complain of localized epigastric pain that occurs when the stomach is empty and that is relieved by food or antacids.

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weight loss or vomitting

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Dietary modifications.
1. Encourage small, frequent meals.
2. Nonstimulating, bland foods are generally tolerated better during healing of acute episodes.
3. Assist client to identify specific dietary habits that exacerbate or precipitate pain.
4. Promote good nutritional habits.

difficulty in swallowing .

is essential for the absorption of vitamin b-12 which is needed for erythropoesis (formation of RBC's)

blood levels and adverse effects may be increased by enzyme inhibitors

dopamine releasing agent

causes urine to turn red

one tablet can be taken every 5 minutes up to 3 doses. Should be taken at the onset of angina

A high fat diet increases the absorption

drug of choice to treat overdose of tricyclic antidepressants

administer the dose a few hours before bedtime

clinical manifestations of drug toxicity

causes pupillary constriction (miosis) so outflow aqueous humor in eye is increased ( decreasing intraocular pressure)

urinary analgesic to relieve pain associated with chronic urinary tract infections. Can be taken with food to decrease gastric irritation.

causes respiratory depression so take vital signs 1st.

irreversible fatal bone marrow depression so the nurse should monitor platelet count

work to increase the availability of acetylcholine at cholinergic synapses, assists in memory formation.

causes CNS effects of sedation and decreased thirst. Many people take this to control tics and vocalizations

systemic absorption of a medication

requires cardiac function studies to monitor cardiac toxic effects

pulse is over 100 beats per minute, to prevent insomnia the dose should be taken early in the morning.. glucose is not affected by thyroid preparations.

gum disease is common so brush and floss teeth!

valium

avoid alcohol ingestion b/c of possibility of antabuse reaction

10-20

acidify the urine, decreasing the incidence of calculi and UTI's.

kidneys

photosensitivity

administer the med at breakfast and after lunch. Doses should be spaced at 8 hour intervals.

photosensitivity

med should be taken with evening meal

inhibit enzymes necessary for cell function and replication

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notified

1)Aspirin
2) suppression of inflammation, relief of mild to moderate pain, reduction of fever, and reduction of thrombus formation (secondary to suppression of platelet aggregation).
3) gastric ulceration, renal impairment, and increased bleeding tendencies (secondary to suppression of platelet aggregation).
4) true
5) gastric ulceration, bleeding, and renal impairment.
6)reduces inflammation and pain.

common in clients older than 30 years of age whose occupations require prolonged standing. Varicose veins are also frequently seen in pregnant women, clients with systemic problems (e.g., heart disease), obese clients, and clients with a family history of varicose veins.

Trendelenburg test assists with the diagnosis. The client is placed in a supine position with elevated legs. As the client sits up, the veins would normally fill from the distal end; however, if there are varicosities, the veins fill from the proximal end.

4 mm in diameter or are in clusters. The stab avulsion technique may be used if the saphenous veins are competent. The surgeon exposes varices through 2- to 3-mm stab incisions, grasping the veins with hooks, and dividing and avulsing each vein.
postop- client needs to keep legs elevated. perform rom excercises,

Primary varicose veins often result from a congenital or familial predisposition that leads to loss of elasticity of the vein wall. Secondary varicosities occur when trauma, obstruction, DVT, or inflammation causes damage to valves.

The Perthes test is used to evaluate the patency of deep veins. With the patient supine and the extremity elevated, occlude the subcutaneous veins with a tourniquet just above the knee to prevent filling of superficial varicosities from above. As the patient walks, muscular tension will act on the deep veins and empty the dilated superficial varicosities. When these superficial veins fail to empty, suspect that the deep veins are also incompetent.

The dosage should be low initially and then increased gradually until full replacement doses have been achieved. A typical dosing schedule consists of 50 μg daily (PO) for 2 weeks followed by 100 μg daily for 2 additional weeks. Thereafter, daily doses of 100 to 150 μg are taken for life. When calculated on a body weight basis, the average adult dose is about 1.7 μg/kg/day.

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Theophylline toxicity.. distractibility, poor school performance, nausea, tachycardia, and irritability; seizures and arrhythmias occur at blood theophylline levels greater than 30 μg/ml.
narrow therapeutic range, less effective but longer duration of action than beta agonists. Smoking cigarettes (one to two packs a day) accelerates metabolism and decreases the half-life of theophylline by about 50%

Cleanse meatus with one front-to-back motion with each of three cleansing sponges.

Keep labia separated throughout procedure.

give patients a sterile urine cup, sterile disinfectant wipes, and clean gloves. The cup and disinfectant wipes are often prepackaged together. The package usually contains instructions, but instruct the patient in how to wash and how to collect the specimen. Anxiety, difficulty or inability to read, or language barriers will prevent the patient from fully comprehending the instructions independently.

Instruct female patients to use the disinfectant wipes to clean from the meatus toward the rectum. Instruct men to clean the meatus in a circular motion moving from the center of the meatus to the outside. Caution the patient against wiping repeatedly with the contaminated cloth. The patient then opens a sterile urine cup. Tell your patient to start and discard the initial stream into a toilet or bedpan. This cleans or flushes the urethral orifice and meatus of resident bacteria. During the midstream, or middle portion of voiding, collect the specimen. Immediately after obtaining the specimen, place a sterile top securely over the container and send it to the laboratory for testing.

Most urinary drainage systems have a self-sealing, covered specimen collection port built into the top of the drainage tubing. Clean this area, then aspirate the specimen with a sterile needle and syringe. You may need to clamp the tubing below the port for 15 to 20 minutes to allow enough urine to accumulate.

If there is no collection port and the catheter is not rubber-like silicone (Silastic), use a small 25-gauge needle and syringe to aspirate urine from the catheter itself.

15 minutes for four times, every 30 minutes for four times, every 2 hours for four times, and then every 4 hours for 24 to 48 hours if the client's condition is stable. Thereafter, vital signs are assessed according to the facility's policy, the client's condition, and the nurse's judgment.

high pitched crowing sound

airway obstruction resulting from tracheal or laryngeal spasm or edema, mucus in the airway, or blockage of the airway from edema or tongue relaxation. When neuromuscular blocking agents are retained, the client has muscle weakness, which could affect gas exchange. Indicators of muscle weakness include the inability to maintain a head lift, weak hand grasps, and an abdominal breathing pattern.

(a difference between the apical and peripheral pulses) could indicate a dysrhythmia.

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true.. if you are a smoker it takes longer

true.. healing is not totally complete for up to two years until the scar is strengthened

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outlining it with a pen and indicating the date and time.. also check the area underneath it may leak!

Drainage on the dressing is expected with open tube drains but is not expected with closed drainage systems. Assess closed-suction drains, such as Hemovac, VacuDrain, and Jackson-Pratt drains, for maintenance of suction. A T-tube may be placed after abdominal cholecystectomy to drain bile. Figure 22-3 shows commonly used drains. Monitor the amount, color, and type of drainage while the client is in the PACU and at least every 8 hours after the client is transferred to the medical-surgical nursing unit. Large amounts of sanguineous drainage may indicate internal bleeding.

Anticholinergics: traditional antidepressants, antiparkinsonian agents, neuroleptics
• Antihistamines: over-the-counter remedies for cold, flu, sleep
• Antiarrhythmics: quinidine
• Sedative-hypnotics: benzodiazepines
• Narcotic analgesics
• Histamine-2 receptor blockers: cimetidine
• Anticonvulsants
• Beta-blockers
• Antihypertensives
• Corticosteroids
• Antibiotics

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then it is left open to heal from the fascia to the skin, and special wound handling must occur. Measures can include wound packing, dressings, drains, ostomy bags, and so on, depending on wound size and location and drainage from the wound. Measure and record the amount of drainage every shift for comparison with earlier assessments to guide potential care plan changes

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Locked-in syndrome is a condition in which the motor pathways in the brainstem are destroyed but the RAS and higher cognitive functions remain intact. In this state, patients are unable to move or speak because of destruction of the motor pathways that control those functions, but they are capable of interacting with their environment. The motor functions of blinking and extraocular movements are usually spared because those pathways lie above the level of the pons. Locked-in patients therefore can communicate with eye movements and are capable of full arousal and understanding.

Abnormal flexion of the arms at the elbows, wrists, and hands with concurrent extension of the legs is called decorticate posturing.

Lesions in the motor pathways of the midbrain or upper pons may cause abnormal extension of the arms with hyperpronation of the forearms, which is called decerebrate posturing.

cranial nerve examination. Several specific cranial nerve reflexes are particularly important in assessing altered LOC. Protective reflexes, including gag, corneal, and cough, are checked to assess the patient's ability to protect himself or herself from injury and aspiration

was developed specifically to evaluate head-injured patients, but it can also be effectively used with a wide variety of other neurologic problems (Box 48-4

Glasgow Coma Scale
Eye Opening
4 Spontaneously open
3 Open to verbal request
2 Open with painful stimuli
1 No opening
Best Motor Response
6 Obeys commands
5 Localizes to painful stimulus
4 Withdraws to painful stimulus
3 Abnormal flexion to pain (decorticate posturing)
2 Abnormal extension to pain (decerebrate posturing)
1 No response
scores from three scales: eye opening, verbal response, and motor response. Numbers are assigned to the patient's best response in each area, and notations are made if a scale is not able to be evaluated, such as “eyes swollen shut” or “intubated; unable to test verbal response.” The GCS does not take the place of a comprehensive neurologic examination, but the cumulative results can be graphed and used to identify trends in the patient's overall function and predict outcomes.

For formula-fed infants, commercial cow's milk formulas are usually adequate, although frequently a hydrolysate formula with medium-chain triglycerides (e.g., Pregestimil or Alimentum) may be recommended. Enzymes are mixed into cereal or fruit, such as applesauce. Because the uptake of fat-soluble vitamins is decreased, water-miscible forms of these vitamins (A, D, E, K) are given, along with multivitamins and the enzymes. In CF constipation is often a result from malabsorption

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they also have salt depletion when they sweat so salty skin. (Gatorade is good to help with this)

lipase, amylase, chymotrypsin, and trypsin.
enzymes are secreted into the duodenum, where they help digest fats, carbohydrates, and proteins. To protect these enzymes from stomach acid and pepsin, the pancreas secretes bicarbonate. The bicarbonate neutralizes acid in the duodenum, and the resulting elevation in pH inactivates pepsin.

Pancreatin is made from hog or beef pancreas. Pancrelipase is made from hog pancreas. Pancrelipase has enzyme activity far greater than that of pancreatin. As a result, pancrelipase is the preferred preparation. Trade names for pancrelipase include Viokase, Lipram, Pancrease MT, and Pancrecarb MS.

True..Their purpose is to reduce gastric pH, thereby protecting the enzymes from inactivation. However, these adjuvants are beneficial only when secretion of gastric acid is excessive.

30-degree angle. If elevating the head of the bed is not advisable, then position client on his/her right side.

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For pulmonary infection, home IV antibiotics are typically prescribed. Home IV care is preferred for willing and competent families, because it reduces tension and usually brings a sense of belonging to the family members. With use of the venous access devices, such as percutaneously inserted central catheters (or PICC lines), the parents and child are taught the technique of direct administration into the IV line.

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The standard method of diagnosis has been the sweat test, which will reveal sweat chloride concentration in excess of 60 mEq/L

Treatment is primarily focused on pulmonary health and on nutrition

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hypoglycemic

The client usually awakens with a headache and reports night sweats and nightmares. Management of the dawn phenomenon involves increasing the bedtime dose of insulin. Hyperglycemia on awakening

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1 With an insulin syringe and needle, inject air, equal to the dose of insulin to be withdrawn, into the vial of intermediate- or long-acting (cloudy) insulin. Do not touch the tip of the needle to the solution.
2 Remove the syringe from the vial of cloudy insulin.
3 With the same syringe, inject air, equal to the dose of insulin to be withdrawn, into the vial of rapid- or short-acting insulin (clear vial). Then withdraw the correct dose into the syringe.
4 Remove the syringe from the clear insulin vial after carefully removing air bubbles in the syringe to ensure correct dose.
5 Return to the vial of intermediate- or long-acting (cloudy) insulin, and withdraw the correct dose.
6 Administer mixture of insulins within 5 minutes of preparing it. Rapid- or short-acting insulin can bind with intermediate- or long-acting insulin, thus reducing the action of the faster-acting insulin.

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The level of A1C increases when individuals have prolonged hyperglycemic serum levels. Red blood cells have a life span of 4 months; therefore a measurement of A1C will give the prescriber an evaluation of the client's long-term diabetic control. An elevated A1C indicates inadequate diabetic control for the previous 2 to 3 months

The insulin pump is battery-operated and connected to a small computer that is programmed to release small amounts of insulin per hour (see Figure 5-8). It does not analyze the blood glucose level, but it is programmed according to the client's daily insulin needs, diet, and physical exercise. The client can also push a button that releases a bolus dose to cover each meal consumed.

Drugs Reported to Cause Hyperglycemia or Hypoglycemia

HYPERGLYCEMIA HYPOGLYCEMIA
atypical antipsychotics (e.g., olanzepine, risperidol) ACE inhibitors
β blockers anabolic steroids
calcium channel blocking agents alcohol
clonidine β-adrenergic blocking agents
corticosteroids β blockers
danazol bromocriptine
diuretics clofibrate
epinephrine ketoconazole
estrogen lithium
estrogen-progestin-containing hormonal contraceptives mebendazole
glucagon NSAIDs
growth hormone octreotide
heparin pyridoxine
H2 receptor blockers sulfonamides
morphine theophylline
phenytoin
sulfinpyrazone
thyroid hormones

PLASMA GLUCOSE LEVEL RESPONSE/SYMPTOM[†]
>70 mg/dL None
70 mg/dL Counterregulation (decreased insulin secretion, increased glucagon secretion, initial epinephrine release)
60 mg/dL Autonomic response (sweating, increased heart rate secondary to epinephrine release)
50 mg/dL Neuroglycopenic (lightheadedness)
40 mg/dL Lethargy
30 mg/dL Coma
20 mg/dL Seizures
10 mg/dL Permanent brain damage/death
0 mg/dL Death
*Symptoms masked by β-adrenergic blockers.

The sulfonylureas enhance the release of insulin from the beta cells in the pancreas, decrease liver glycogenolysis (the breakdown of glycogen stored in the liver to glucose) and gluconeogenesis (the formation of glycogen from fatty acids and proteins rather than from carbohydrates), and increase cellular sensitivity to insulin in body tissues. Therefore they reduce the concentration of blood glucose in people with a functioning pancreas.

glyburide and glipizide are the most commonly used sulfa's

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morphine allergy. It is a lipid-soluble agent which has a more rapid onset than morphine and a shorter duration.
it is an effective and safe opiod
preferred agent for acutely distressed patients.
comes in many forms the duragesic patch is the 72 hour patch, requires 12-16 hours for onset of action

the upper torso.. indicated for chronic severe pain, such as that associated with cancer. Because analgesia is delayed, fentanyl patches are not suited for acute or postoperative pain. The patches should not be used in children under 12 years old, or in anyone under 18 who weighs less than 110 pounds. Also, patches should not be used for mild pain that responds to a less powerful analgesic.
*antagonist naloxone

schedule 2

the drug has a short half-life, and hence dosing must be repeated at short intervals. Second, meperidine interacts adversely with a number of drugs. Third, with continuous use, there is a risk of harm owing to accumulation of a toxic metabolite. Accordingly, routine use of the drug should be avoided. However, meperidine may still be appropriate for patients who can't take other opioids, and for patients with drug-induced rigors or post-anesthesia shivering.

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relieve pain and to treat opioid addicts. Usual oral analgesic doses for adults range from 2.5 to 20 mg repeated every 3 to 4 hours as needed.

Remifentanil [Ultiva]

2 mg every 4 to 6 hours.

is available in solution (1 and 1.5 mg/ml) for parenteral administration and in 5-mg rectal suppositories. The initial IV dose is 0.5 mg.

Drugs with a short half-life are usually preferred for occasional or unexpected pain because they tend to have a quicker onset of analgesia than drugs with a long half-life.

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chronic pain!

It is usually given in combination with acetaminophen or aspirin. It can cause constipation, nausea, vomiting, and pruritus

Classification: Nonsteroidal antiinflammatory (NSAID), analgesic.

Action: Blocks prostaglandin synthesis.

Indications: Short-term management of moderate pain.

Dosages and Route: Children older than 2 years intravenous (IV): 0.4-1 mg/kg one time, followed by 0.2-0.5 mg/kg/dose q6h, up to a maximum of 120 mg/24 hr.

Absorption: Absorbed fairly rapidly; peak action in 1 to 2 hr.

Excretion: Excreted in the urine; effects last 4-6 hr.

Contraindications: Contraindicated in patient in whom urticaria, severe rhinitis, bronchospasm, angioedema, nasal polyps are precipitated by other NSAIDs.

Precautions: Cautious use with history of ulcers, impaired hepatic or renal function.

Adverse Reactions: Drowsiness, dizziness, nausea, GI pain, hemorrhage.

Nursing Considerations: Do not administer longer than 5 days; monitor liver function studies, signs and symptoms of GI upset or bleeding.

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The patch should not ever be cut and should be disposed of down the toilet, witnessed by two nurses.

ORAL
Preferred because of convenience, cost, and relatively steady blood levels

Higher dosages of oral form of opioids required for equivalent parenteral analgesia

Peak drug effect occurs after 1-2 hours for most analgesics

Delay in onset is disadvantage when rapid control of severe pain or of fluctuating pain is desired

Tablet or liquid placed between cheek and gum (buccal) or under tongue (sublingual)

Highly desirable because more rapid onset than with oral route

Less first-pass effect through liver than oral route, which normally reduces analgesia from oral opioids (unless sublingual/buccal form swallowed, which occurs often in children)

Few drugs commercially available in this form

Preferred for rapid control of severe pain

Provides most rapid onset of effect, usually in about 5 minutes

Advantage for acute pain, procedural pain, and breakthrough pain
Needs to be repeated hourly for continuous pain control

Drugs with short half-life (morphine, fentanyl, hydromorphone) are preferred, to avoid toxic accumulation of drug

Preferred over bolus and intramuscular injection for maintaining control of pain

Provides steady blood levels

Easy to titrate dosage

Used when oral and IV routes not available

Provides equivalent blood levels to continuous IV infusion

Suggested initial bolus dose to equal 2-hour IV dose; total 24-hour dose usually requires concentrated opioid solution to minimize infused volume. Use smallest gauge needle that accommodates infusion rate

NOT RECOMMENDED FOR PAIN CONTROL; NOT CURRENT STANDARD OF CARE

Buffer the solution by adding 1 part sodium bicarbonate (1 mEq/mL) to 9 to 10 parts 1% or 2% lidocaine with or without epinephrine (see Guidelines box on p. 680)
Normal saline with preservative, benzyl alcohol (except neonates), anesthetizes venipuncture site

Use same dose as for buffered lidocaine (see Guidelines box on p. 680).

covered by occlusive dressing or applied as anesthetic disk for 1 hour or more before procedure

LAT (lidocaine/adrenaline/tetracaine) or tetracaine/phenylephrine (tetraphen)

10-15 seconds before needle puncture

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Fentanyl at a dose of 0.1 mg given intravenously is equivalent to 10 mg of morphine given intramuscularly.

Retinal detachment may occur suddenly or develop slowly. Symptoms include showers of floating spots before the eyes, flashes of light, and progressive loss of vision in one area. The so-called floaters are cells that are freed at the time of the retinal tear, casting shadows on the retina as they drift about the eye. The flashes of light are caused by vitreous traction on the retina. The area of vision loss depends entirely on the location of the detachment. If the detachment extends to include the macula, blindness results. When the detachment is extensive and occurs quickly, the patient may have the sensation that a curtain has been drawn before the eyes. No pain is associated with a detachment.

The most common cause is a retinal break. Retinal breaks are an interruption in the full thickness of the retinal tissue, and they can be classified as tears or holes. Retinal holes are atrophic retinal breaks that occur spontaneously. Retinal tears can occur as the vitreous humor shrinks during aging and pulls on the retina. The retina tears when the traction force exceeds the strength of the retina. Once there is a break in the retina, liquid vitreous can enter the subretinal space between the sensory layer and the retinal pigment epithelium layer, causing a rhegmatogenous retinal detachment. Less frequently, retinal detachment can occur when abnormal membranes mechanically pull on the retina. These are called tractional detachments. A third type of retinal detachment is the secondary or exudative detachment that occurs with conditions that allow fluid to accumulate in the subretinal space (e.g., choroidal tumors, intraocular inflammation)

urgent situation, and the patient is confronted suddenly with the need for surgery. The patient needs emotional support, especially during the immediate preoperative period when preparations for surgery produce additional anxiety. When the patient experiences postoperative pain, the nurse should administer prescribed pain medications and teach the patient to take the medication as necessary after being discharged. The patient may go home within a few hours of surgery or may remain in the hospital for several days, depending on the surgeon and the type of repair. Discharge planning and teaching is important, and the nurse should begin this process as early as possible because the patient may not remain hospitalized long.

a. A cataract is an opacity of the lens that distorts the image projected onto the retina and that can progress to blindness.
b. Causes include the aging process (senile cataracts), inherited (congenital cataracts), and injury (traumatic cataracts); cataracts also can result from another eye disease (secondary cataracts).
c. Intervention is indicated when visual acuity has been reduced to a level that the client finds to be unacceptable or adversely affects lifestyle.

a. Opaque or cloudy white pupil
b. Gradual loss of vision
c. Blurred vision
d. Decreased color perception
e. Vision that is better in dim light with pupil dilation
f. Photophobia
g. Absence of the red reflex

Glaucoma

types of glaucoma

what to do if object piercing the eye?

Developmental Manifestations of Increased Intracranial Pressure
INFANT
• Poor feeding or vomiting
• Irritability or restlessness
• Lethargy
• Bulging fontanel
• High-pitched cry
• Increased head circumference
• Separation of cranial sutures
• Distended scalp veins
• Eyes deviated downward (“setting-sun” sign)
• Increased or decreased response to pain
CHILD
• Headache
• Diplopia
• Mood swings
• Slurred speech
• Papilledema (after 48 hours)
• Altered level of consciousness
• Nausea and vomiting, especially in the morning

With advancing age the lens of the eye becomes less flexible and less adjustable. In addition, the sclera changes shape, causing light to fall on the macula (an opaque portion of the cornea). Thus visual acuity declines with age.

true

true

Full consciousness: awake, alert, oriented, interacts with environment

Confused: lacks ability to think clearly and rapidly

Disoriented: lacks ability to recognize place or person

Lethargic: awakens easily but exhibits limited responsiveness

Obtunded: sleeps unless aroused, and once aroused has limited interaction with the environment

Stupor: requires considerable stimulation to arouse

Coma: vigorous stimulation produces no motor or verbal response

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Cushing's response, which consists of an increased systolic blood pressure with widening pulse pressure, bradycardia, and a change in respiratory rate and pattern, is usually apparent just before or at the time of brain stem herniation. This usually indicates an alteration in brain stem perfusion, with the body attempting to improve cerebral blood flow by increasing blood pressure. In children, Cushing's response is a late sign of increased ICP.

refers to a pattern of breathing characterized by increasing rate and depth and then decreasing rate and depth with a pause of variable length

identified by a rapid rate despite normal arterial blood gas values. This type of breathing pattern usually indicates midbrain or pontine involvement.

occurs when the child demonstrates prolonged inspiration and expiration. As Cushing's response occurs, the child will develop apnea.

Late signs of increased ICP include tachycardia that leads to bradycardia, apnea, systolic hypertension, widening pulse pressure, and decorticate or decerebrate posturing.

progressive neurological deterioration. If the infant's cranial suture lines are open, increased ICP will cause separation of the suture lines and an increase in the circumference of the head.

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pupillary changes occurring on the same side as a cerebral lesion.

high pitched

measures balance. Client stands with feet together and arms at side, first with eyes open, then with eyes closed for 20 to 30 seconds.

How should nurse Position patient with ICP?

glucose and leaves a yellow halo stain

ventricle to right atrium) is reserved for older children who have attained most of their somatic growth and children with abdominal pathology. The VA shunt is contraindicated in children with cardiopulmonary disease or elevated CSF protein.

Endoscopic third ventriculostomy

In infants the head is measured daily at the point of largest measurement—the occipitofrontal circumference (OFC). (See Chapter 7 for technique.) To avoid the likelihood of wide discrepancies, the point at which the measurements are taken is indicated on the head with a marking pen. Fontanels and suture lines are gently palpated for size, signs of bulging, tenseness, and separation. An infant with hydrocephalus and normal ICP will display bulging under certain circumstances such as straining or crying; therefore such accompanying behavior is noted. Irritability, lethargy, or seizure activity, as well as altered vital signs and feeding behavior, may indicate advancing pathology.

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there need be few restrictions placed on the child's activities (mainly contact sports), and the child is encouraged to live as would any other youngster of the same age and abilities.

Setting-sun sign: sclera visible above the iris
Frontal bone enlargement, or bossing
Vomiting; difficulty swallowing or feeding
Increased blood pressure, decreased heart rate
Altered respiratory pattern
Shrill, high-pitched cry
Sluggish or unequal pupillary response to light

Strabismus
Frontal headache that occurs in the morning and is relieved by emesis or by sitting upright
Nausea and vomiting that may be projectile
Diplopia
Restlessness
Behavior or personality changes
Ataxia
Papilledema
Irritability
Sluggish and unequal pupillary response to light
Confusion
Changes in school work
Lethargy

true!

The most important predictor for breast cancer is age; the risk increases as the woman ages.
Female Women account for 99% of breast cancer cases.
Age 50 or over Majority of breast cancers are found in postmenopausal women.
Family history Breast cancer in a first-degree relative, particularly when premenopausal or bilateral, increases risk. Gene mutations (BRCA-1 or BRCA-2) play a role in 5%-10% of breast cancer cases.
Personal history of breast cancer, colon cancer, endometrial cancer, ovarian cancer Personal history significantly increases risk of breast cancer, risk of cancer in other breast, and recurrence.
Early menarche (< age 12); late menopause (> age 55) A long menstrual history increases the risk of breast cancer.
First full-term pregnancy after age 30; nulliparity Prolonged exposure to unopposed estrogen increases risk for breast cancer.
Benign breast disease with atypical epithelial hyperplasia Atypical changes in breast biopsy increase the risk of breast cancer.
Obesity after menopause Fat cells store estrogen.
Exposure to ionizing radiation Radiation damages DNA (e.g., prior treatment for Hodgkin's disease).

When should you have physical examination of the breasts?

Breast self-examination and patient instruction. 1, While in the shower or bath, when the skin is slippery with soap and water, exam-ine your breasts. Use the pads of your second, third, and fourth fingers to firmly press every part of the breast. While examining your left breast, use your right hand, and use your left hand to examine your right breast. Us-ing the pads of the fingers on your left hand, examine the entire breast us-ing small circular motions in a spiral or in an up-and-down motion so that the entire breast area is examined. Repeat the procedure using your right hand to examine your left breast. Repeat pattern of palpation under the arm. Check for any lump, hard knot, or thickening of the tissue. 2, Look at your breasts in a mirror. Stand with your arms at your side. 3, Raise your arms overhead and check for any changes in the shape of your breasts, dimpling of the skin, or any changes in the nipple. 4, Next, place your hands on your hips and press down firmly, tightening the pectoral mus-cles. Observe for asymmetry or changes, keeping in mind that your breasts probably do not exactly match. 5, While lying down, feel your breasts as described in step 1. When examining your right breast, place a folded towel under your right shoulder and put your right hand behind your head. Repeat the procedure while examining your left breast. Mark your calendar that you have completed your BSE; note any changes or unique characteristics you want to check with your health care

good light and should include inspection before a mirror and careful, systematic palpation. The entire breast, axilla, and clavicle should be examined. The woman should be taught the BSE procedure by a health care provider using the woman's own hand on her breast. A gentle circular motion over wet, soapy skin is particularly useful if she is in the shower. The woman should be told what to look for, such as a lump, nipple discharge, nipple retraction, redness, pain or tenderness, dimpling of the skin, or edema. Some teaching techniques involve using silicone breast models that simulate normal and abnormal breast tissue to help women learn to identify problems. The woman should be shown the normal variations in her own breasts so that she will be able to detect changes. Finally, she should be reminded that most breast problems are not related to malignancy. At every annual physical examination the health care provider should ask the woman to demonstrate how she performs BSE.

African American women have lower survival rates from breast cancer than white women, even when diagnosed at an early stage.
• African American women are diagnosed at a later stage of breast cancer than white women, but this fact alone does not account for the higher mortality rate.
• White women have a higher incidence of breast cancer than nonwhites.
• Breast cancer is the most commonly diagnosed cancer among Hispanic women.
• Hispanic women, especially Mexican Americans, have the lowest rate of cancer screening of any ethnic group.
• Hispanic women tend to have larger, more advanced tumors, which may relate to their higher mortality rate compared with white women.
• Hispanic women are more likely to be diagnosed at a later stage of breast cancer than white women.

The most frequently occurring cancer of the breast is

Primary tumor cannot be assessed

no evidence of primary tumor

Carcinoma in situ: intraductal carcinoma, lobular carcinoma in situ, or Paget disease of the nipple with node

Tumor 2 cm or less in greatest dimension

Tumor more than 2 cm but not more than 5 cm in greatest dimension

Tumor more than 5 cm in greatest dimension
Tumor of any size with direct extension to chest wall or skin

Sildenafil (Viagra) is a prescription medication that is commonly ordered for ED, but not without concerns and cautions for the patient. This is especially true for geriatric patients, who generally have other medical conditions (e.g., renal disorders, hypertension, diabetes) and are usually taking more than one other prescribed medication.

headache, flushing, urinary tract infection, diarrhea, rash, and dizziness. Viagra should be used cautiously in patients who have cardiac disease and angina because these patients are at greater risk for complications, even more so if they are also on nitrates for their cardiovascular disease. This is especially problematic for the patient over 65 years of age who is self-medicating.

true.. also sitting in a bathroom with a steaming shower will help

True! It affects children younger than 5 years of age, and the causative organisms are the parainfluenza virus, RSV, influenza A and B, and Mycoplasma pneumoniae. The disease is usually preceded by a URI, which gradually descends to adjacent structures. It is characterized by gradual onset of low-grade fever. Inflammation of the mucosa lining of the larynx and trachea causes a narrowing of the airway. When the airway is significantly narrowed, the child struggles to inhale air past the obstruction and into the lungs, producing the characteristic inspiratory stridor and suprasternal retractions. The classic barking or seal-like cough and acute stridor. Children with severe respiratory distress (traditionally, a respiratory rate greater than 60 breaths/min for infants) should not be given anything by mouth to prevent aspiration and decrease the work of breathing.

Nebulized epinephrine (racemic epinephrine) is often used in children with severe disease, stridor at rest, retractions, or difficulty breathing. The α-adrenergic effects cause mucosal vasoconstriction and subsequently decrease subglottic edema. The onset of action is rapid, and the peak effect is observed in 2 hours. Additional doses may be administered every 20 to 30 minutes in the intensive care unit or 3 to 4 hours in the regular hospital unit. The use of corticosteroids is beneficial because the antiinflammatory effects decrease subglottic edema. The onset of action is clinically detectable as early as 6 hours after administration, with continued improvement over 12 to 24 hours.

It is essential to allow children with mild croup to drink beverages they like and to encourage their parents to try whatever comforting measures work best (e.g., holding their child, rocking, singing). If the child is unable to take oral fluids, IV fluid therapy may be indicated.

increased pulse and respiratory rate; substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness

Protest:
Child is agitated, resists caregivers, cries, and is inconsolable.

Despair:
Child experiences hopelessness and becomes quiet, withdrawn, and apathetic.

Detachment:
Child becomes interested in the environment, plays, and seems to form relationships with caregivers and other children. If parents reappear, the child may ignore them.

infants and toddlers between 6 and 30 months

Inflammation of the trachea and major bronchi is present in bronchitis. Mucus production is increased, and the mucosa is congested. Because of nonspecific leukocytic migration, purulent secretions can occur even in the absence of a bacterial infection.

Acute bronchitis is a self-limiting disease. Chronic bronchitis in children may indicate an underlying chronic respiratory dysfunction.more common during the winter months

gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough with increased mucus production. Auscultation may reveal coarse and fine, moist crackles and high-pitched rhonchi (resembling the wheezing of asthma). Associated symptoms include malaise, low-grade fever, and increased mucus, which may be purulent.

Chest radiographs are usually normal. The diagnosis is based on the clinical picture.

Treatment is mainly symptomatic and includes rest, humidification, and increased fluid intake. Exposure to cigarette smoke should be avoided. Cough suppressants are not recommended unless the cough interferes with the child's ability to rest. Antihistamines should be avoided because of their drying effect on secretions. Antibiotics should be given only if a bacterial infection is confirmed by culture or if the clinical picture supports the diagnosis.

enlarged spleen..Mild splenic enlargement occurs with congestive heart failure and systemic lupus erythematosus.massive splenic enlargement occurs with chronic myelogenous leukemia, hairy cell leukemia, and thalassemia major.

Causes of splenomegaly

signs of splenomegaly..

when the spleen enlarges normal filtering and sequestering capacity?

immunologic system after splenectomy.

The primary cause of PD is an imbalance in two neurotransmitters—dopamine (DA) and acetylcholine (ACh)—in the area of the brain called the basal ganglia. This imbalance is caused by failure of the nerve terminals in the substantia nigra to produce the essential neurotransmitter dopamine. This neurotransmitter acts in the basal ganglia to control movements. Destruction of the substantia nigra leads to dopamine depletion. Dopamine is an inhibitory neurotransmitter, and ACh is an excitatory neurotransmitter in this area of the brain. A correct balance between these two neurotransmitters is needed for the proper regulation of posture, muscle tone, and voluntary movement. Patients who suffer from PD have an imbalance in these neurotransmitters, usually a deficiency of dopamine in the substantia nigra areas of the brain, as mentioned previously. This dopamine deficiency can also lead to excessive ACh (cholinergic) activity due to the lack of a normal dopaminergic balancing effect.

parkinsons tx

metabolized in the liver and can cause hepatotoxicity

helps them become aware of their positive qualities and increase self confidence, also aids in coping with past and present situations.

require decreased stimuli and a structured environment. Plan noncompetitive activities that can be carried out alone

photosensitivity

trust and have low self esteem

indicative of gonorrhea, so if you see a 8 year old child with this suspect child abuse.

need med regimen
families need to know the signs of exacerbation
chronic grief associated with long term illness

depressed

offer support without judgement or demands
ex) Come with me to your room and I will sit with you.

enroll the client in a excersise class to promote positive self esteem

give the client a liquid diet and do not argue with the clients delusions

true

psychomotor impairment

true

levels below 2 meq.. follow a progressive pattern beginning with diarrhea, vomitting, and drowsiness and muscle weakness. Higher levels- ataxia, blurred vision, tinnitis, and large dilute urine.

when the voices tell him to do things that cause self harm

true

feelings of guilt so the nurse should help direct awareness to the client

fever, rigidity, encephalopathy, it is a life threatening reaction to neuroleptic drugs.

fear of crowds or being in a open space

weight gain, so client should have a well balanced diet and excersise

symbolization

great the client by first name and provide short frequent contact to establish trust.

an attempt to be like someone or emulate personality traits of someone.